Standard and double dose ipratropium bromide and combined ipratropium bromide and inhaled metaproterenol in COPD

Chest. 1989 May;95(5):1013-6. doi: 10.1378/chest.95.5.1013.


Inhaled ipratropium bromide (IPR) is effective in the management of COPD. The purpose of this study was to determine if doubling the standard dose of IPR resulted in greater bronchodilation and if the addition of an inhaled beta-agonist was superior to standard dose IPR alone. Twelve male patients with stable COPD completed a double blind, randomized trial. On each of three consecutive days, following baseline spirometry, all patients inhaled two puffs of IPR. This was followed by either two additional puffs of IPR, two puffs of metaproterenol (META), or two puffs of placebo. All inhalants were delivered by an InspirEase spacer. Spirometry was repeated at 30, 60, 120, and 180 minutes. The group mean percentage increases in the FEV1 and FVC from baseline were similar at all times tested for the three protocols. In conclusion, for the group, there was no objective benefit to doubling the standard dose of IPR or combining IPR with META. Two of 12 patients benefited from combining the two bronchodilators. A potential sequence for bronchodilator testing is suggested.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Aged
  • Atropine Derivatives / administration & dosage*
  • Double-Blind Method
  • Drug Combinations
  • Forced Expiratory Volume
  • Humans
  • Ipratropium / administration & dosage*
  • Ipratropium / therapeutic use
  • Lung Diseases, Obstructive / drug therapy
  • Lung Diseases, Obstructive / physiopathology*
  • Male
  • Metaproterenol / administration & dosage*
  • Metaproterenol / therapeutic use
  • Middle Aged
  • Placebos
  • Random Allocation
  • Spirometry
  • Vital Capacity


  • Atropine Derivatives
  • Drug Combinations
  • Placebos
  • Metaproterenol
  • Ipratropium